1. 門診處方討論 - Colchicine for Recurrent aphthous stomatitis(RAS) 報告日期 : 98.11.26 報告日期 : 98.11.26 報告人 : 黃梁灝 藥師 報告人 : 黃梁灝 藥師

2. (metformin) 處方 :

3. 98..04.1098..04.19 A patient suffered from recurrent oral ulcer for one year. No arthralgia, no skin rash, no genital ulcer was noted. No erythema nodusum 【 stomatitis 】 98/4/17 three oral ulcer, slightly improved A patient suffered from recurrent oral ulcer for one year. No arthralgia, no skin rash, no genital ulcer was noted. No erythema nodusum Past history : Diabetes mellitus(--), Hypertension (--) Operation history (--)Drugs allergy history(--) Travel history(-) Family history: non-contributory Past history : Diabetes mellitus(--), Hypertension (--) 病人病史及診斷 :

5. 此處方之問題 請問 Colchicine 是否可以使用於復發性口腔炎 之治療 ? 請問 Colchicine 是否可以使用於復發性口腔炎 之治療 ? 請問 Colchicine 應用於復發性口腔炎治療之劑 量 ? 請問 Colchicine 應用於復發性口腔炎治療之劑 量 ? 請問 Colchicine 應用於復發性口腔炎治療其應 注意之事項為何 ? 請問 Colchicine 應用於復發性口腔炎治療其應 注意之事項為何 ? -- 會有什麼副作用 ? -- 會有什麼副作用 ?

6. Classification(1) Aphthous stomatitis is divided, on morphologic criterion, into 3 clinical presentations. It is unclear whether these presentations are manifestations of a specific disease or they represent other oral disorders characterized by recurrent ulcer. The clinical presentations of RAS include minor, major, and herpetiform aphthae. Pediatr Infect Dis J 2007;26: 728 – 732)

7. Classification(2)

8. Classification(3) Minor Majorherpetiform

9. Differential Diagnosis of Recurrent Mouth Ulcers (1) NEJM 2006;355(2): 165-172

10. Differential Diagnosis of Recurrent Mouth Ulcers (2) NEJM 2006;355(2): 165-172

11. Differential Diagnosis of Recurrent Mouth Ulcers (3)

12. Guidelines for Management of Aphthous Stomatitis Goals in the management of RAS reflect that it is generally mild and self-limiting, and that, currently, there is no treatment widely believed to be curative. Treatments that reduce pain during attacks or reduce ulcer number and size, promote healing of existing ulceration, frequency of recurrent attacks with minimal adverse side effects are considered successful. Treatments used for this generally benign disease should not be associated with more morbidity that the disease itself. Pediatr Infect Dis J 2007;26: 728 – 732)

13. The American Academy of Oral Medicine has recommended topical treatments for RAS. Topical medications include anesthetics, antihistamines, antimicrobials, and anti- inflammatory agents. Evidence of successful use of these agents for aphthous ulcers is primarily anecdotal. Pediatr Infect Dis J 2007;26: 728 – 732)

14. Other Therapies to Consider for Recurrent Aphthous Stomatitis (1) NEJM 2006;355(2): 165-172

15. Other Therapies to Consider for Recurrent Aphthous Stomatitis (2) NEJM 2006;355(2): 165-172

16. Colchicine 於復發性口腔炎治療之機轉 Cholchicine mechanism is interference with neutrophil function and migration. Most patients with common aphthosis respond well to cholchicine by decreased number and duration of lesions, although it is not always effective in all types of recurrent aphthosis.

17. An open, prospective, 4-month study was conducted in 20 patients with RAS who served as their own controls. During the first 2 months of the study no medications were given and in the last 2 months colchicine, 1.5 mg/day, was prescribed. An open, prospective, 4-month study was conducted in 20 patients with RAS who served as their own controls. During the first 2 months of the study no medications were given and in the last 2 months colchicine, 1.5 mg/day, was prescribed. Colchicine 於復發性口腔炎治療之臨床證據 (1) Reference: Journal of the American Academy of Dermatology. 1994; 31(3 Pt 1):459-61.

18. The mean number of aphthae per week and the subjective daily pain scores were reduced by 71% and 77%, respectively, during colchicine treatment as compared with the previous period (p < 0.001 for both). No serious side effects of colchicine were noted. The mean number of aphthae per week and the subjective daily pain scores were reduced by 71% and 77%, respectively, during colchicine treatment as compared with the previous period (p < 0.001 for both). No serious side effects of colchicine were noted. These findings suggest a role for continuous colchicine therapy in the prevention of RAS. These findings suggest a role for continuous colchicine therapy in the prevention of RAS. Reference: Journal of the American Academy of Dermatology. 1994; 31(3 Pt 1):459-61.

19. Colchicine 於復發性口腔炎治療之臨床證據 (2) In an open-label study not involving placebo control, 20 patients with recurrent aphthous stomatitis were assessed at baseline (no therapy) and during treatment with oral colchicine 0.5 mg three times daily, each for a period of two months (Katz et al, 1994). Patients demonstrated a notable decrease in the number of aphthous lesions and a reduction in pain while being treated with colchicine. In an open-label study not involving placebo control, 20 patients with recurrent aphthous stomatitis were assessed at baseline (no therapy) and during treatment with oral colchicine 0.5 mg three times daily, each for a period of two months (Katz et al, 1994). Patients demonstrated a notable decrease in the number of aphthous lesions and a reduction in pain while being treated with colchicine. Oral colchicine in a dose of 0.6-1.2 mg daily was effective in the treatment of protracted aphthous stomatitis in 4 patients (Gatot & Tovi, 1984). Oral colchicine in a dose of 0.6-1.2 mg daily was effective in the treatment of protracted aphthous stomatitis in 4 patients (Gatot & Tovi, 1984). From Micromidex

20. Colchicine 於復發性口腔炎治療之臨床證據 (3) Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8. Referevence: PURPOSE: This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS: An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset.

21. Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8. Referevence:

22. Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8. Referevence:

23. The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5%). Dapsone was prescribed for a total of nine patients, of whom eight (89%) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90%), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60%), of whom one patient showed complete remission.

24. Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8. Referevence:

25. 請問 Colchicine 應用於復 發性口腔炎治療之劑量

26. 臨床研究使用劑量分別為 臨床研究使用劑量分別為 1 to 1.5 mg/day (Ref ？ ) 1 to 1.5 mg/day (Ref ？ ) 0.5 to 1 mg/day (Ref ？ ) 0.5 to 1 mg/day (Ref ？ ) Colchicine 應用於復發性口腔炎治療之劑量

27. 請問 Colchicine 應用於復 發性口腔炎治療其應注意 之事項為何 ? -- 會有什麼副作用 ?

28. 急性痛風使用 Colchicine 最高劑量為 8mg/day, 而 Colchicine 用於 RAS 的劑量約為 0.5~1.5mg/day ，且治療期間不長，副作用 比較少見。 (Ref ？ ) 急性痛風使用 Colchicine 最高劑量為 8mg/day, 而 Colchicine 用於 RAS 的劑量約為 0.5~1.5mg/day ，且治療期間不長，副作用 比較少見。 (Ref ？ ) 但仍須小心監測其噁心、嘔吐、腹瀉等副作用 的產生。 (Ref ？ ) 但仍須小心監測其噁心、嘔吐、腹瀉等副作用 的產生。 (Ref ？ )

29. Recommendation and evidence ratings of colchicine FDA Approval: Adult, no; Pediatric, no FDA Approval: Adult, no; Pediatric, no Efficacy: Adult, Evidence favors efficacy Efficacy: Adult, Evidence favors efficacy Recommendation: Adult, Class IIb Recommendation: Adult, Class IIb Strength of Evidence: Adult, Category B Strength of Evidence: Adult, Category B Colchicine demonstrated good results and was well tolerated by the patiens. Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8 Colchicine demonstrated good results and was well tolerated by the patiens. Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8

30. Reference 1. Prevention of recurrent aphthous stomatitis with colchicine: An open trial. 1. Prevention of recurrent aphthous stomatitis with colchicine: An open trial. Journal of the American Academy of Dermatology. 1994; 31(3 Pt 1):459-61. 2. Systemic treatment in severe cases of recurrent aphthous stomatitis:an open trial. Clinics. 2009;64(3):193-8. 3. 3. Practical aspects of management of recurrent aphthous stomatitis. JEADV 2007,21, 1019–1026 Journal compilation c 2007 European Academy of Dermatology and Venereology. 4. 基層醫學 第二十二卷第一期 4. 慈濟綜合醫院大林分院 家庭醫學科 基層醫學 第二十二卷第一期 5. 基層醫學 第二十二卷第十期 5. 慈濟綜合醫院大林分院 家庭醫學科 基層醫學 第二十二卷第十期